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Health condition · Clinically reviewed

Broken heart syndrome, a heart attack mimic that usually recovers.

Takotsubo cardiomyopathy is a reversible stunning of the left ventricle after intense stress. Recognised early and managed well, most people recover fully within weeks.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against ESC, BSE and peer-reviewed cardiology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK cardiology practice including InterTAK criteria and shock management.

Key facts

Broken heart syndrome at a glance.

The essentials in plain English, what it is, who it affects and how UK cardiology teams manage it.

  • What it is

    Takotsubo cardiomyopathy, a reversible acute left ventricular dysfunction triggered by emotional or physical stress that mimics a heart attack.

  • Who it affects

    Around 90 per cent of cases occur in postmenopausal women, often after bereavement, surgery or acute illness.

  • Mechanism

    A surge of catecholamines causes microvascular spasm and apical stunning, with spontaneous recovery over days to weeks.

  • Presentation

    Sudden chest pain, breathlessness and ECG changes indistinguishable from acute coronary syndrome at first look.

  • Diagnosis

    Coronary angiogram shows unobstructed arteries alongside apical ballooning on the LV-gram or echocardiogram.

  • Recovery

    Left ventricular function usually normalises within four to eight weeks with supportive care and heart failure therapy.

Why this guide matters

A frightening event with a hopeful outlook.

The three points below shape how UK cardiology teams approach Takotsubo cardiomyopathy from the emergency department onwards.

  • It looks like a heart attack

    ST elevation, troponin rise and chest pain make angiography essential to exclude obstructive coronary disease before the diagnosis is confirmed.

  • It is largely reversible

    Apical stunning recovers over four to eight weeks in most patients, guided by supportive care and standard heart failure therapy.

  • Shock is managed without inotropes

    Catecholamines worsen the underlying injury, so mechanical circulatory support is preferred when blood pressure is failing.

How the diagnosis is made

From ACS pathway to a confirmed diagnosis.

The steps a UK cardiology team will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    ACS pathway and troponin

    Sudden chest pain with ST elevation triggers the standard acute coronary syndrome pathway, with serial troponin and ECG.

  2. 02

    Assessing

    Urgent coronary angiogram

    Angiography is essential to exclude obstructive coronary disease, which is the defining first step.

  3. 03

    Assessing

    LV-gram or echocardiogram

    Apical ballooning with basal hypercontractility is the classic pattern, though midventricular, basal and focal variants exist.

  4. 04

    Confirming

    InterTAK diagnostic criteria

    Score-based criteria combining sex, trigger, ECG and biomarkers help distinguish Takotsubo from acute coronary syndrome.

  5. 05

    Confirming

    Cardiac MRI

    Confirms wall-motion pattern and shows absence of delayed gadolinium enhancement, which rules out infarction and myocarditis.

  6. 06

    Following up

    Screen for phaeochromocytoma

    Plasma or urinary metanephrines are checked when the presentation is recurrent, atypical or without a clear trigger.

  7. 07

    Following up

    Cardiology follow-up

    Repeat echocardiogram at four to eight weeks documents recovery of left ventricular function and guides therapy withdrawal.

Typical timeline: diagnosis within 24 to 48 hours, recovery over four to eight weeks.

Symptoms

What Takotsubo actually looks like.

The classic mix of ACS-mimicking chest pain, ECG changes and imaging findings, plus the features that mean urgent escalation.

  • Sudden chest pain

    A crushing central chest pain that comes on within minutes of an emotional or physical trigger.

  • Breathlessness

    Acute dyspnoea from pulmonary congestion as the stunned apex fails to pump effectively.

  • ST elevation and T inversion

    ECG changes that look like an anterior STEMI, often followed by deep T-wave inversion and QT prolongation.

  • Troponin rise

    A modest troponin rise, typically smaller than expected for the size of the ventricular dysfunction.

  • Apical ballooning on imaging

    The classic pot-shaped left ventricle with a ballooning apex and vigorous base on ventriculography.

  • Palpitations and syncope

    Arrhythmias including atrial fibrillation, ventricular tachycardia and, rarely, torsades de pointes.

  • Cardiogenic shock

    Low blood pressure and poor perfusion in up to a fifth of patients, sometimes with dynamic LVOT obstruction.

  • Red flag, haemodynamic collapse

    Rapid deterioration warrants urgent transfer to a centre with mechanical circulatory support.

Treatment

How Takotsubo is managed in the UK.

Supportive care, heart failure therapy and, where needed, mechanical circulatory support rather than inotropes.

  • Supportive intensive care

    Close cardiac monitoring, treatment of the underlying trigger and careful fluid balance during the acute stunning phase.

  • Heart failure therapy

    ACE inhibitor or ARB, beta blocker and a diuretic if congested, continued until echocardiographic recovery.

  • Antiplatelet

    Aspirin is often started on the acute coronary syndrome pathway then stopped once coronary disease has been excluded.

  • Anticoagulation for LV thrombus

    A three-month course of anticoagulation is used when apical thrombus is detected on echocardiogram or MRI.

  • Mechanical circulatory support

    Intra-aortic balloon pump, Impella or ECMO for cardiogenic shock, since inotropes may worsen catecholamine-driven injury.

  • LVOT obstruction management

    Cautious beta blockade, intravenous fluid and phenylephrine to reduce the outflow gradient, avoiding inotropes.

  • Arrhythmia treatment

    Magnesium and QT-sparing measures for torsades, with standard management of atrial and ventricular arrhythmias.

  • Recurrence prevention

    Long-term beta blockade is often used despite limited evidence, alongside stress-reduction and psychological support.

What this guide is based on

The sources behind every claim on this page.

European and UK cardiology guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your cardiology team knows your heart and history and can tell you which parts apply to you. If in doubt, get seen.

  • European Society of Cardiology. Position statement on Takotsubo syndrome (2018 and updates).

  • British Society of Echocardiography. Guidance on left ventricular assessment.

  • InterTAK Registry. Diagnostic criteria and outcomes for Takotsubo syndrome.

  • Cardiomyopathy UK. Patient information on Takotsubo cardiomyopathy.

Red flags

When Takotsubo needs urgent escalation.

Most patients recover well. These are the situations that need higher acuity care, mechanical support or specialist follow-up.

  • Cardiogenic shock

    Persistent hypotension and poor perfusion require urgent transfer for mechanical circulatory support rather than inotropes.

  • Dynamic LVOT obstruction

    A new systolic murmur with a hyperdynamic base can cause obstruction, worsened by inotropes and improved by fluid and beta blockade.

  • Left ventricular thrombus

    Apical akinesia predisposes to thrombus formation and systemic embolism, requiring three months of anticoagulation.

  • Ventricular rupture

    A rare but catastrophic complication of severe apical wall thinning, presenting as sudden collapse or tamponade.

  • Ventricular arrhythmia and torsades

    QT prolongation during the acute phase can trigger torsades de pointes, managed with magnesium and cautious rate control.

  • Recurrence

    Around five per cent of patients experience a further episode each year, often with a different trigger or pattern.

  • Suspected phaeochromocytoma

    Recurrent or unexplained Takotsubo warrants screening with plasma or urinary metanephrines.

  • Iatrogenic adrenaline exposure

    Recent adrenaline, dobutamine or high-dose sympathomimetics can precipitate the syndrome and should be reviewed.

  • Ongoing psychological distress

    Grief, anxiety and post-traumatic stress after the trigger event deserve early referral to psychology or IAPT services.

Living with it

A reversible condition, with a clear recovery path.

Four things that make the biggest difference during recovery, from staying on medication to protecting your mental health after a frightening event.

A quiet reminder

Recovery is usually complete, but rarely instant.

Give the heart four to eight weeks, keep taking your medicines, and lean on your cardiology team and Cardiomyopathy UK if you need support.

  1. 01 Recovery

    Expect steady improvement

    Most people recover normal heart function within four to eight weeks, with symptoms easing over the same timescale.

  2. 02 Therapy

    Stay on your medicines

    Heart failure medicines are continued until follow-up imaging confirms full recovery, then gradually reduced.

  3. 03 Support

    Look after your mind

    Stress management, talking therapy and support from Cardiomyopathy UK can help after a frightening event.

  4. 04 Watch

    Know the recurrence signs

    Sudden chest pain or breathlessness after a stressful event deserves urgent review, as a small proportion of patients relapse.

Frequently asked

Everything we get asked about broken heart syndrome.

Quick answers on diagnosis, treatment, recovery and recurrence.

  • What is broken heart syndrome?

    Broken heart syndrome, also called Takotsubo cardiomyopathy or stress cardiomyopathy, is a reversible weakening of the left ventricle triggered by intense emotional or physical stress. It mimics a heart attack but the coronary arteries are usually unobstructed and the heart recovers over days to weeks.

  • Who is most at risk?

    Around ninety per cent of cases occur in postmenopausal women. Common triggers include bereavement, major surgery, acute medical illness, phaeochromocytoma and drugs such as adrenaline or dobutamine.

  • How is it diagnosed?

    A coronary angiogram is essential to exclude obstructive coronary disease. Echocardiography or ventriculography then shows the classic apical ballooning pattern, and cardiac MRI helps rule out infarction and myocarditis. The InterTAK criteria bring these findings together.

  • How is it treated?

    Care is supportive with ACE inhibitors or ARBs, beta blockers and diuretics as needed. Anticoagulation is used for three months if a left ventricular thrombus is present. Cardiogenic shock is managed with mechanical circulatory support rather than inotropes, since catecholamines can worsen the injury.

  • Can it come back?

    Around five per cent of patients experience a recurrence each year. Long-term beta blockade is often prescribed, although evidence is limited, and stress reduction and psychological support form an important part of prevention.

  • Does the heart fully recover?

    In most cases yes. Left ventricular function usually normalises within four to eight weeks and a repeat echocardiogram at that point guides the withdrawal of heart failure therapy.

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